{
"topic": "Alopecia Areata",
"slug": "alopecia-areata",
"category_id": 15273,
"passage_count": 14,
"source_chars": 12915,
"enough_material": true,
"references": [
{
"title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition",
"author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.",
"pages": [
450
]
},
{
"title": "Cover",
"author": "Vitalsource Download",
"pages": [
4995
]
},
{
"title": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan)",
"author": null,
"pages": [
530
]
},
{
"title": "MedStudy Pediatrics Core 11th Edition 2024-2025",
"author": null,
"pages": [
852
]
},
{
"title": "Signs and Symptoms in Pediatrics",
"author": "Henry M. Adam,Jane Meschan Foy",
"pages": [
56,
59
]
},
{
"title": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga)",
"author": "CamScanner",
"pages": [
691
]
},
{
"title": "The Harriet Lane Handbook (The Johns Hopkins Hospital)",
"author": null,
"pages": [
251
]
},
{
"title": "The Harriet Lane Handbook 22nd Edition (2020) (The Johns Hopkins Hospital)",
"author": null,
"pages": [
251
]
}
],
"passages": [
{
"source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 450",
"text": "## **1. Alopecia Areata** ## \u00bb **Clinical Findings** Complete hair loss in a localized area is called alopecia areata. This is the most common cause of hair loss in children. An immunologic pathogenic mechanism is suspected because dense infiltration of lymphocytes precedes hair loss. Fifty percent of children with alopecia areata completely regrow their hair within 12 months, although as many may have a relapse in the future. **Table 15\u20137.** Other causes of hair loss in children. - **Hair loss with scalp changes** Atrophy: - Lichen planus - Lupus erythematosus - Birthmarks: - Epidermal nevus - Nevus sebaceous - Aplasia cutis congenita **Hair loss with hair shaft defects (hair fails to grow out enough to require haircuts)** - Monilethrix\u2014alternating bands of thin and thick areas - Pili annulati\u2014alternating bands of light and dark pigmentation Pili torti\u2014hair twisted 180 degrees, brittle - Trichorrhexis invaginata (bamboo hair)\u2014intussusception of one hair into another"
},
{
"source": "Cover, p. 4995",
"text": "Alopecia areata is a common nonscarring alopecia characterized by the sudden appearance of round or oval patches of hair loss on the scalp. Eyebrows or eyelashes can be affected as well. The condition may have its onset as early as birth but usually first appears in children and young adults. It is an autoimmune disorder with a genetic predisposition and can be associated with other autoimmune diseases such as Hashimoto thyroiditis, myasthenia gravis, diabetes, and vitiligo. Most children with alopecia areata do not have concomitant autoimmune disease, but clinicians should consider evaluation if the clinical picture is suggestive. The typical lesion of alopecia areata is a smooth, shiny, hairless, round patch of the scalp that appears suddenly over the course of several days. Scattered long hairs within the bald area or \u201cexclamation point hairs\u201d (hairs with a narrowed proximal diameter and often shorter length and lighter color) may be detected. The nails may be affected with variable pitting."
},
{
"source": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan), p. 530",
"text": "_Alopecia areata_ is a common form of hair loss in childhood, affecting about 1\u20132% of the population and characterized by a sudden onset of patchy hair loss on the scalp. It is considered an autoimmune condition, and it has been shown to be more common in children with CD [141], once again even in the complete absence of GI manifestations. Good response to the GFD has been observed [120]. Children with CD have an increased frequency of _neurological symptoms_ compared to controls [142]. The most common is definitely headache [143\u2013145] that appears in 18% of children [145] and in most cases responds well to the GFD [120]; but also peripheral neuropathy [142] and seizures [146] are well described; ataxia on the other hand is described almost exclusively in adult cases [147]. The prevalence of epilepsy in CD children also appears to be higher than expected, as reported in a recent large epidemiologic"
},
{
"source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 852",
"text": "of age). In patients with a papulopustular component, topical metronidazole is often effective in the treatment of mild-to-moderate cases. Oral tetracyclines are often ben- eficial in a more severe disease and may be combined with a topical agent. Oral retinoids may lead to improvement in patients not responding to initial therapies. Avoidance of potential triggers, appropriate sun protection, and gentle skin care should be emphasized in all patients. ALOPECIA Alopecia Areata Alopecia areata is an autoimmune process in which the immune system attacks the hair follicles. This is among the more common causes of hair loss and presents as sudden-onset round or oval patches of hair loss on the scalp (Figure 18-36). Body hair in other locations can also be affected. In con- trast to tinea capitis, there is no clinically appreciable inflammation, scale, pruri- tus, or lymphadenopathy with alopecia areata. It is often seen in school-age children but is rarely seen in"
},
{
"source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 852",
"text": "with alopecia areata. It is often seen in school-age children but is rarely seen in infants. Alopecia areata is occasionally associated with other autoimmune diseases, including chronic autoim- mune thyroiditis (a.k.a. Hashimoto thyroiditis, chronic lymphocytic thyroiditis), primary adrenal insufficiency, Type 1 diabetes mellitus, psoriasis, and vitiligo. Alopecia Figure 18-36: Alopecia areata \u00a9 2023 MedStudy\u2014Please Report Copyright Infringements to copyright@medstudy.com ##"
},
{
"source": "Signs and Symptoms in Pediatrics, p. 59",
"text": "Whenever a child has patches of alopecia or stubbly hair growth, even in the absence of crusting, scaling, redness, or other infl ammatory signs, the physician should consider the possibility of tinea capitis, along with seborrheic dermatitis, atopic dermatitis, or psoriasis (Figure 3-3). Certainly, seborrhea and atopy are more common in children than fungal scalp infection; but particularly when alopecia is accompanied by local adenopathy, tinea capitis should be in the diff erential diagnosis.[9] Obviously, if crusting, scaling, or redness is present, then the likelihood of alopecia areata is diminished because infl ammation is not a symptom of that condition. In any event, the practitioner should perform a mycologic examination, looking particularly for the usual fungus, _Trichophyton tonsurans._ Clinically, the lesions tend to be more elevated than in other forms of tinea and may be characterized by black dots. In rare cases, the endothrix fungi _Microsporum canis_ and _Microsporum audouinii_ can invade"
},
{
"source": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga), p. 691",
"text": "[Figure OCR, page 691, figure 1] a <* | Essential Pediatrics Fig. 26.42: (a) Alopecia areata: Noncicatricial, non- Inflammatory, discold lesions with exclamation mark halr at periphery; (b) Alopecia totalls: Total loss of terminal hair from scalp, face and body totalis, there is total alopecia in the scalp, while in alopecia universalis there is total loss of terminal hair from scalp, eyebrows, eyelashes, beard and body (Fig. 26.42b). Nails may occasionally show fine pitting and thinning of the nail plate. Spontaneous remission is common. Initially, the regrowing hairs are grey, but regain color over period of time. Poor prognostic features include onset in childhood, ophiasis, association with atopy and widespread alopecia. Treatment Treatment depends on extent and course of disease (Table 26.10). | Millaria Etlology Miliaria is due to obstruction and rupture of eccrine sweat ducts resulting in spillage of sweat into adjacent epidermis/dermis. Depending on the level of rupture, miliaria is classified into:"
},
{
"source": "The Harriet Lane Handbook (The Johns Hopkins Hospital), p. 251",
"text": "3. **Treatment:** Self- limited. Regrowth usually occurs over several months. - **B. Alopecia Areata (see Fig. 8.19, Color Plates)** 1. **Clinical presentation:** Chronic inflammatory (probably autoimmune) disease that starts with well- circumscribed small bald patches and normal- appearing underlying skin. New lesions may demonstrate subtle erythema and be pruritic. Bald patches may enlarge to involve large **200 Part II** Diagnostic and Therapeutic Information hair regrowth within 1 to 2 years, although most will relapse. A minority progress to total loss of all scalp (alopecia totalis) and/or body hair (alopecia universalis). 2. **Diagnosis:** Usually clinical diagnosis. 3. **Treatment**[13] : First- line therapy is topical steroids. Referral to dermatology is warranted for consideration of other treatments. No evidence- based data that any therapy is better than placebo. Older children, adolescents, and young adults with longstanding localized areas of hair loss have the best prognosis."
},
{
"source": "The Harriet Lane Handbook 22nd Edition (2020) (The Johns Hopkins Hospital), p. 251",
"text": "3. **Treatment:** Self- limited. Regrowth usually occurs over several months. - **B. Alopecia Areata (see Fig. 8.19, Color Plates)** 1. **Clinical presentation:** Chronic inflammatory (probably autoimmune) disease that starts with well- circumscribed small bald patches and normal- appearing underlying skin. New lesions may demonstrate subtle erythema and be pruritic. Bald patches may enlarge to involve large **200 Part II** Diagnostic and Therapeutic Information hair regrowth within 1 to 2 years, although most will relapse. A minority progress to total loss of all scalp (alopecia totalis) and/or body hair (alopecia universalis). 2. **Diagnosis:** Usually clinical diagnosis. 3. **Treatment**[13] : First- line therapy is topical steroids. Referral to dermatology is warranted for consideration of other treatments. No evidence- based data that any therapy is better than placebo. Older children, adolescents, and young adults with longstanding localized areas of hair loss have the best prognosis."
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 4180",
"text": "Alopecia areata is characterized by rapid and complete loss of hair in round or oval patches on the scalp (Fig. 703.4), eyebrows, eyelashes, and on other body sites. In alopecia totalis, all the scalp hair is lost (Fig. 703.5 ); alopecia universalis involves all body and scalp hair. The lifetime incidence of alopecia areata is 0.1\u20130.2% of the population. More than half of affected patients are younger than 20 years of age. The skin within the plaques of hair loss appears normal. Alopecia areata is associated with atopy and with nail changes such as pits (Fig. 703.6), longitudinal striations, and leukonychia. Autoimmune diseases such as Hashimoto thyroiditis, Addison disease, pernicious anemia, ulcerative colitis, myasthenia gravis, collagen vascular diseases, and vitiligo may also be seen. An increased incidence of alopecia areata has been reported in patients with Down syndrome (5\u201310%). ## **Differential Diagnosis**"
},
{
"source": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online, p. 385",
"text": "**Figure 8-133** Alopecia areata. **A,** Patches of complete hair loss with otherwise normal scalp are typical of this disorder. **B,** In this close-up, small broken hairs that pull out easily are seen at the margins. **C,** In this boy the process has progressed to alopecia totalis. Note that even his eyebrows are involved. _(_ _**C,** Courtesy Michael Sherlock, MD, Lutherville, Md.)_  **----- Start of picture text -----**
A
**----- End of picture text -----**
 **----- Start of picture text -----**
C
**----- End of picture text -----**
 **----- Start of picture text -----**
B
**----- End of picture text -----**
**362** Zitelli and Davis\u2019 Atlas of Pediatric Physical Diagnosis "
},
{
"source": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll), p. 463",
"text": "## **Alopecia areata** This is a common form of hair loss in children and, understandably, a cause of much family distress. Hairless, single or multiple non-inflamed smooth areas of skin, usually over the scalp, are present (Fig. 25.17); remnants of broken-off hairs, visible as \u2018exclamation mark\u2019 hairs may be seen at the edge of active patches of hair fall. The more extensive the hair loss, the poorer the prognosis, but regrowth often occurs within 6 months to 12 months in localized hair loss. Prognosis should be more guarded in children with atopic disorders. ## **Granuloma annulare** Lesions are typically ringed (annular) with a raised flesh-coloured nonscaling edge (unlike ringworm; Fig. 25.18). They may occur anywhere but usually over bony prominences, especially over hands and feet. Lesions may be single or multiple, are usually 1\u20133 cm in diameter, and tend to disappear spontaneously but may take years to do so. There is also a subcutaneous form. 450 "
},
{
"source": "Signs and Symptoms in Pediatrics, p. 56",
"text": "## _**Alopecia Areata**_ Alopecia areata, most often seen as an acute problem, results in a sudden and total loss of hair in sharply circumscribed, round areas, often several centimeters in diameter, usually on the scalp, but possibly anywhere on the body where hair is found (Figure 3-1). Hairs at the periphery of an area are plucked easily and may be particularly colorless and thin. _Exclamation-point hairs_ (broken hairs with a narrow bulb) may appear throughout the patch, which is sometimes salmon colored as a manifestation of the presumed infl ammation seen histologically around the hair follicle. Th e fi ngernails may be pitted, possibly indicating a more extensive ectodermal problem."
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 4180",
"text": "**Differential Diagnosis.** Acute reactional hair pulling, tinea capitis, and alopecia areata must be considered in the differential diagnosis of trichotillomania (see Tables 703.4 and 703.5). > **Treatment.** Trichotillomania is closely related to obsessivecompulsive disorder and may be an expression of it for some children. When trichotillomania occurs secondary to obsessive- compulsive disorder, clomipramine 50- 150 mg/day or a selective serotonin reuptake inhibitor (SSRI) such as fluoxetine may be helpful, particularly when combined with behavioral interventions (see Chapter 37). _N_ - Acetylcysteine may also be helpful. ## **ALOPECIA AREATA** ## **Etiology and Pathogenesis** Alopecia areata is a T- cell\u2013driven autoimmune disorder producing nonscarring alopecia. The cause is unknown. It is hypothesized that in genetically susceptible individuals, loss of immune privilege of the hair follicle allows for T- cell inflammation against anagen hairs and follicles, leading to stoppage of hair growth."
}
]
}